http://http//www.ncbi.nlm.nih.gov/pubmed/21141080 Here is the link to a new article about a plan at one seattle area Emergency Department that has greatly reduced the amount of narcotics prescribed. Pretty interesting, but really extreme. Maybe this is what we need now?

Bitemporal Hemianopsia

Bitemporal Hemianopsia

vision missing in the lateral, temporal half ofboth visual fields. Caused by compression of the optic nerve at the optic chiasm, affecting the bilateral medial retina. Most often due to tumors of the pituitary that are forced to expand upward because of the bony "saddle" they sit in, the sella turcica, or turkey saddle. Here you see an interesting example direct from the number one most frequently used medical resource, wikipedia. This example shows two views of Paris. The second obviously with bitemporal hemianopsia. Loved these pictures, and love wiki, so had to post them. Enjoy.

Back and Bigger and Better

We are back! Yes, I couldnt stand to stay in private mode any longer, nothing to post for. Screw the gestapo! Of course, I did have to delete several posts that I had posted during the time the blog went under the radar, but no matter. The Hog Blog is coming back and with more posts, more stories, more case reports, and more bullshit than ever. And I have a special, heart warming, story to celebrate with......Recently, a young lady with crohn's has made multiple visits to our emergency department. She has a jejunostomy, and she has had various episodes of cracking and bleeding around the ostomy site. After much prodding on her fifth visit for the same complaint, she admits that she is actually a prostitute, and she is selling sex with her ostomy site! We called her the "Ostitute"!

Paul Broun

Paul Broun, The doctor turned Congressman from Athens, GA who allowed rhetoric about assasinating Obama to go unchallenged at his own rally is a disgrace to both of the professions he represents. His inaction and complacence is no better than that of Sarah Palin or the silent under Hitler. Let me say, he does not represent all doctors. Unfortunatly, he does likely represent the majority, but definetly not the majority of ED docs. or is it spelled Paul braun?

Primum non what?

Primum non nocerem (sp?) What about first do nothing, primoris, operor nusquam? I think that was the fat man's motto, and it served those guys well enough, not doing bad for me either.

Difficult Family

A particularly difficult family member was my problem recently. a real pain in my ass. His mother, an 89 year old bed bound nursing home pt, was dying. Shitting blood and bleeding out through the gut. She looked like a picture of death when she rolled through the door, and my first move was to look for a code status, which I fully expected should have been "Do not Resuscitate." It was not. We all began to mutter under our breaths and slowly began to work on the unfortunate woman. Torture her, we said. We were just preparing to intubate when they brought her son back. He was in tears. Didn't he expect this? Despite pointed questions and multiple attempts, he was adamant that the woman should be full code. We intubated her, put in a central line, and began dumping in fluids and uncrossed blood. Her initial hemoglobin was 4.4. She coded multiple times, and we collapsed her chest wall with our compressions. I made repeated visits to the son in the family room; updating, and occasionally pleading the case to withdraw support. He had family members on the way, could we just keep her going until they arrived? He was crying constantly. We worked for three hours, diverting care from younger, healthier patients who just had to wait. Finally, the grandchildren arrived, and slowly, after much talk with the chaplain, the nurses, and myself, the man decided to withdraw support. The woman went quietly, in a darkened room, surrounded by family. When it was over the man hugged me, thanking me repeatedly. He cried some more, and this time I cried as well. I had bought him the time he needed to come to grips with his mother's death. Maybe I still resented him a little for what I felt was prolonging her misery, but at that moment I felt understanding for his point of view, and I realized that often we feel family members are "difficult" or hard to deal with, largely because they just dont agree with exactly what we think should happen, and the decision does not rest solely with us.

darkness

The trauma service amd its 100 hour weeks is even worse in the winter. You miss all the short day light hours and find yourself inside all day, in only the faded glow of the flourescent lights. depression descends quickly under these conditions, amongst the death and mayhem.

Interesting Shift

The most interesting shift Ive had in a while had its ups and downs. I had a homicidal maniac who the cops had to taze after he threatened to kill me and the cop and was screaming, shaking and flipped the bed over. It was also a night of nasty pelvics. Started with 210 kg pregnant lady with vag bleeding, then there was a girl who hid a pouch of tobacco in her vagina when going into jail and lost it for two weeks and I had to go digging. it was the second time she had done the same thing in a month. didnt she learn? The whole room stunk before she ever took her clothes off and pus was flowwing out. first case of fitz hugh curtis ive seen. whats worse this thanksgiving day was like a hospital frequent flyer all stars day. all of our frequent flying psych pts were in, some multiple times. I think they were lonely on the holidays and we are reallly like their family. the higghlight of the shift was the save i made in the nursery, the one day old who was dropped on her head and had an epidural. the pediatrician was sitting on his hands, wanting an mri, etc. what the kid needed was a peds neurosurgeon and i pushed until we got it...saved maybe my first life that shift